一位周邊動脈阻塞性疾病病人接受截肢之護理經驗

A Nursing Experience of an Amputated Patient with Peripheral Arterial Occlusive Disease

糖尿病併周邊動脈阻塞，會造成肢體缺血而產生疼痛、間歇性跛行，甚而壞死。若未能控制飲食及維持良好生活習慣，嚴重者可能需進行截肢手術。本文描述一位59歲糖尿病個案，因周邊動脈阻塞性疾病(peripheral arterial occlusion disease, PAOD)，導致右足壞死，先行周邊動靜脈血管擴張術失敗後，進行截肢手術，面臨永久性肢體殘缺，內心衝擊之身心照護經驗。照護期間2019年04月28日至05月21日，運用Gordon十一項功能性健康型態評估，藉由觀察、會談、病歷查閱、實際照護等方式收集資料，確立有急性疼痛、身體活動功能障礙、身體心像改變之健康照護問題。照護期間，與個案建立良好護病關係，鼓勵表達內心感受，給予持續支持及關心。藉由聽音樂、肌肉放鬆技巧等方式轉移疼痛注意力；透過截肢肢體運動手冊，增加肌肉強度及張力，促進個案自我照護；運用鏡像治療協助個案認知身體的改變，使個案能面對並接受截肢的事實，分享激勵影片及介紹相關成功案例，強化個案自信心與復原動機。截肢後個案不論在日常工作或是社會角色等可能受到巨大影響，建議臨床護理師在個案疼痛改善後可介紹相關成功案例，增進信心，藉以強化復原動機，以期達到盡早回歸社會及恢復生活品質之目的。

Diabetes accompanied with peripheral arterial obstruction can cause pain, intermittent claudication, and even necrosis of the limbs. In severe cases due to poor diet control and bad living habits, it may lead to the requirement of limb amputation. This article describes the experience of nursing care for the patient under psychological and physical shock after limb amputation. The subject is a 59-year-old diabetic patient who suffered from peripheral arterial occlusion disease (PAOD), which led to necrosis of the right foot. After the failure of the first peripheral arterial-venous vasodilation, she underwent limb amputation and faced permanent disability. To acknowledge the existence of acute pain and physical function obstacles in physical and mental health, data are collected through observation, interviews, medical history review, actual care, etc. using Gordon's eleven functional health assessments during the nursing period from April 28 to May 21, 2019. The subject was encouraged to express feelings and given persistent care and support to create a better nursing environment. Physical pains were eased by listening to music and applying muscle relaxation techniques. Muscle strength and tension were enhanced to promote self-care capability according to the direction of the post-amputation exercise manual. Using Mirror therapy, motivational videos, and introducing related successful cases, to help the subject confront the physical changes, and regain self-confidence and recovery motivation. The result showed that the patient was able to recover sooner both mentally and physically.